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Hospital Beds Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for hospital beds HCPCS codes E0260, E0261, and E0303 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 13.80%. The top 10 reasons for claim denials are as follows:

Rank Reason Percent
1. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 44.74%
2. The documentation does not have a valid Standard Written Order (SWO). 13.16%
3. The SWO is missing a description of the item. 7.89%
4. The treating practitioner's order, supplier prepared statement, or the practitioner's attestation, by itself, does not show enough documentation of medical necessity. 7.89%
5. The documentation is incomplete. 5.26%
6. We did not receive any medical record documentation. 5.26%
7. Medical records do not support that the beneficiary needs frequent changes in body position and/or has an immediate need for a change in body position. 5.26%
8. Medical records do not support that the beneficiary meets one of the four criteria for a fixed height hospital bed. 5.26%
9. The medical records received lack sufficient information concerning the beneficiary's condition to determine if medical necessity coverage criteria were met. 2.63%
10. The documentation was not timely (within the preceding 12 months) to support continued need by the beneficiary. 2.63%

*The total percentage will be greater than 100% because some claims denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.

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Updated: May 21, 2024

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